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Flashcards in Week 3 Deck (86)
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1
Q

What is diaschisis

A

sudden inhibition of function secondary to neurophysiological changes that occur distant to the focal brain lesion

2
Q

What is tPA stand for

A

tissue plasminogen activator

3
Q

what is the penumbra

A

moderately ischaemic tissue that surrounds the ischaemic core

is viable for up to 6 hours

4
Q

What is the leading treatment for ischaemic stroke

A

tPA: thrombolysis

5
Q

What is the time frame that tPA can be delivered in

A

up to 4.5 hours post symptom onset

6
Q

neurointervention involves

A

intra-arterial thrombolysis and mechanical clot removal

7
Q

Antithrombotic therapy involves

A

ingestion of aspirin orally/NGT/suppository within 48 hours after onset of stroke
-only if imaging excludes haemorrhage

8
Q

If patients have received thrombolysis, how long do they have to wait until they can take aspirin

A

should be deferred for 24 hours and only prescribed if follow up imaging has excluded haemorrhage

9
Q

Acute phase blood pressure lowering therapy can be used in ischaemic stroke id

A

BP is >220/120

no reductions past 10-20%

10
Q

in acute primary intracerebral haemorrhage, with severe hypertension observed, Acute phase BP lowering therapy can be used

A

to maintain SBP <180mmHg

11
Q

If the patient is already on antihypertensive therapy, what should you do

A

continue provided there is no symptomatic hypotension or any other reason to withhold

12
Q

What are the current recommendations for patients with large MCA infarcts in terms of cerebral oedema

A

patients should urgently referred for consideration of decompressive hemicranectomy, due to the increased intra cranial pressure

13
Q

Are corticosteroids recommended for management of brain oedema and raised ICP

A

no

14
Q

Main focus of management in intracerebral haemorrhage management

A

rapid assessment
routine investigations
prevention of complications

15
Q

Current recommendations in intracerebral haemorrhage management include

A

haemostatic drug treatment with rFVlla is experimental and not recommended for use

for patients receiving anticoagulation therapy prior to stroke and who have elevated INR, therapy to reverse anticoagulation should be initiated rapidly

surgical evacuation may be undertaken for cerebellar hemisphere haematomas >3cm in selected patients

16
Q

Current recommendations involving physiological monitoring include

A

check of neurological status (GCS), Vital signs (HR, BP, Temp, Spo2, and glucose levels) and respiratory pattern monitored and documented regularly during the acute phase

frequency of observations should be determined by the patient’s status

17
Q

Current recommendations for oxygen therapy includes

A

patients who are hypoxic (<95% oxygens sats) should be given supplemental oxygen

The routine use of supplemental oxygen is not recommended in acute stroke patients who are not hypoxic

18
Q

prevalence of hyperglycemia in patients following stroke is

A

1/3

19
Q

Current recommendations for glycaemic control includes

A

blood glucose monitoring (on admission) and appropriate glycaemic therapy instituted

20
Q

Pyrexia is

A

“fancy word for fever” increased body temperature

21
Q

pyrexia is associated with

A

poorer outcomes after stroke

22
Q

common causes of pyrexia include

A

Respiratory or urinary infections

23
Q

Current recommendations for pyrexia

A

antipyretic therapy, comprising regular paracetamol and / or physical cooling measures should be used routinely where fever occurs

24
Q

Current recommendations for seizure management are

A

anticonvulsant meds to be used for patients with recurrent seizures post stroke

25
Q

What is spasticity

A

motor disorder characterised by a velocity dependant increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks resulting from hyper-excitability of the stretch reflex as one component of the upper motor neurone syndrome

26
Q

When should interventions to reduce spasticity be undertaken

A

when the level of spasticity interferes with activity or the ability to care to the patient

27
Q

what can be used as an intervention to decrease level of spasticity

A

botulinum toxin A - should be trialled in conjunction with rehab

electrical stimualtion and or EMG biofeedback can be used

28
Q

What is a contracture

A

shortening of soft tissue that results in reduced joint ROM due to impairments (weakness or spasticity)

29
Q

What can be used to prevent contracture

A

conventional therapy for those at risk of contracture `

the routine use of splints or prolonged positioning of muscles in lengthened positions is not recommended

30
Q

Usual position of hemiplegic limbs following ABI

A
Upper limb
-Shx : abd/IR
Elb, Wrx and fingers : F
Forearm : pronation 
Thumb : adduction 
Lower limb 
- Supine
Hip: ER
Knee: E
Ankle: PF

Sitting position
Hip : F/ER
Knee : F
Ankle : slight PF

31
Q

Conventional therapy for contracture includes

A

Encouraging active movement
target muscles most at risk of shortening
Implement a positioning program for UL/LL between therapy times and during rest periods

Joints at risk of contracture should be positioned >20-30 minutes in outer range
Passive positioning should be routine ward protocol
Aim to keep humerus in the plane of the scapula
Teach patients to attend to their own arm

32
Q

Subluxation definition

A

partial or incomplete dislocation that usually stems from changes in the mechanical integrity of the joint

head of humerus is lowered relative to the glenoid cavity (anterior and inferior)

33
Q

What causes subluxation

A

Weakness (especially supraspinatus and deltoid)
Overextensibility of capsular structures
Spasticity

34
Q

When is a subluxation most likely to happen

A

in the first three weeks

35
Q

subluxation can be associated with

A

poor upper limb function
shoulder pain
reflex sympathetic dystrophy (now CRPS)

36
Q

Management of patients with severe weakness who are at risk of developing a subluxed shoulder includes

A

electrical stimulation
firm support devices (hemiplegic sling, collar and cuff, wheelchair attachments

Education and training for the patient, family/carer and clinical staff on correct handling and positioning

37
Q

Management for patients who have a subluxed shoulder includes

A

firm support devices

38
Q

Evidence behind the functional electrical stimulation

A

Evidence supports use in early management of stroke (<2/12) for the prevention of subluxation

Recommended to commence within 48 hours of stroke for patients with a MAS score of <4 for UL items

Applied to posterior deltoid and supraspinatus

39
Q

Parameters for the functional electrical stimulation

A

30 Hz
Daily - commence 1 hour/day - 6hours /day

commence with 1: 3 on/off cycle and gradually increase duration of on cycle and decrease duration of off cycle

Cease once the MAS score for UL items is 4

40
Q

Indications for shoulder strapping

A

reduce shoulder pain
reduce glenohumeral subluxation (most effective when applied with slings)
Facilitate appropriate glenohumeral and scapulothoracic alignment
facilitate or inhibit muscle activity

41
Q

Disadvantages of shoulder strapping

A

skin irritation
needs to be applied by someone with experience
requires regular application (aim for 1-2x per week to reduce skin irritation)

42
Q

What is central post stroke pain (CPSP)

A

superficial and unpleasant burning, lancinating or prickling sensation, often made worse by touch, water or movement
refer to neurologist or specialist

43
Q

Swelling of the extremities can happen when

A

patients are immobile with limbs in dependant positions

- swelling of hands and feet

44
Q

Prevention strategies for swelling of the extremities

A

dynamic pressure garments
electrical stimulation
limb elevation whilst resting

45
Q

management of swelling of the extremities

A

dynamic pressure garments
electrical stimulation
limb elevation whilst resting
continuous passive motion with elevation

46
Q

Why does loss of cardiorespiratory fitness occur

A

deconditioning occurs as a result of the immobility imposed early after stroke

rehab should include interventions aimed at increasing cardiorespiratory fitness once patients have sufficient strength in the large LL muscle groups

Patients should be encouraged to undertake regular ongoing fitness training

47
Q

Define fatigue

A

abnormal or pathological fatigue characterised by weakness unrelated to previous exertion levels and is usually not ameliorated by rest

48
Q

Prevalence of fatigue in long term

A

16-70%

49
Q

When should therapy for patients experiencing fatigue be done

A

periods of the day when they are most alert

50
Q

management strategies for fatigue

A

exercise
establishing good sleep patterns
avoidance of sedatives
avoidance of excessive alcohol

51
Q

Incontinence

A

dysfunction of the bladder or bowel may be caused by a combination of stroke related impairments ( eg. weakness, cognitive or perceptual impairments)
pelvic floor exercises

52
Q

Pressure care is used for

A

pressure ulcers are areas of localised damage to the skin and underlying tissue due to pressure, shear or friction

53
Q

who should get pressure care

A

all stroke survivors are at risk therefore they should have pressure care risk assessment and regular evaluation

all high risk patients should be provided with appropriate pressure relieving aids and strategies including a pressure relieving mattress

54
Q

Main strategies for treatment (pressure care)

A

local treatment of wound (dressings, topical applications)
Pressure relief (beds, mattresses, cushions, patient repositioning)
Treatment of concurrent conditions which may delay healing (poor nutrition, infection )
EStim(electromagnetic, US, Laser)

55
Q

prevalence of falls in inpatients

A

79% at risk

56
Q

do balance and mobility predict falls

A

no

57
Q

what should intervention target to reduce falls risk

A

stroke specific problems such as difficulty standing

58
Q

when should falls risk assessment be undertaken

A

on admission to hospital

59
Q

ICF analysis includes

A

environmental factors
personal factors
functioning factors
physical impairments

60
Q

treatment plans include

A

SMART goals
specific treatment strategies for each problem
identify resting positions (bed/chair)
Identify handling/assistance requirements for health pros or family/carer during bed mobility, transfers, sitting, standing and mobility
identify mobility level
identify practice that can be carried out independently by patient or with assistance from family/carer

61
Q

Functional activity retraining is centred around

A

bed mobility, sitting balance, sit to stand, standing balance, transfers, gait, UL function, outdoor/community mobility and high level balance

62
Q

Strengthening is centred around

A

targeted areas of weakness with consideration of optimisation for neuroplasticity

63
Q

flexibility treatment is centred around

A

management and prevention

64
Q

What types of specific impairments might need to be considered as part of any treatment plan

A
respiratory dysfunction
pain
oedema
subluxation 
joint stiffness
vestibular dysfunction
65
Q

Ways to maximise sensory feedback to ensure optimal motor performance

A

visual feedback : mirrors, video, targets, scales
Auditory feedback : verbal, biofeedback
Sensory feedback : handling, tactile facilitation, strapping, compression (bandaging/tubigrip)

66
Q

What are the aims of physiotherapy following stroke

A
prevent/manage secondary complications
optimise cardiorespiratory function 
optimise motor performance 
increase physical fitness and strength
inspire interest and motivation 
promote mental and physical vigour
67
Q

what are some benefits of physiotherapy in stroke cases

A

prevention of complications such as contracture, subluxation, swelling of extremities, pressure ulcers, falls
fatigue
loss of cardiorespiratory fitness
improved positioning and handling by health professionals and the family/carer
overcoming learned non-use or compensations through positive movement experiences
management of impairments such as weakness, sensory loss, flexibility, tone and spasticity

68
Q

How much?

A

rehab should be structured to provide as much practice as possible within the first 6 m after stroke
minimum PT 1h/day 5x/week

task specific circuit classes/video self modelling can increase amount of practice
pts should be encouraged to practice skills learnt in therapy throughout the remainder of the day

69
Q

Timing

A

patients should be mobilised as early and as frequently as possible
upper limb training should commence early
acutely, commence as soon as possible with frequent short sessions out of bed

70
Q

Weakness

A

most common impairment
most significant contributor to reduced function

one or more interventions used
- progressive resistance exercises
Estim
EMB biofeedback in conjunction with conventional therapy

71
Q

loss of sensation

A

sensory specific training can be provided to stroke survivors who have sensory loss
sensory training designed to facilitate transfer can also be provided to stroke survivors who have sensory loss

72
Q

visual loss

A

patients who appear to have difficulty with recognising objects or people should be screened using specific assessment tools and if a deficit is found, referred for comprehensive assessment by relevant health professional

73
Q

Sitting

A

practising reaching beyond arm’s length while sitting with supervision/assistance should be undertaken by people who have difficulty sitting
Practice should ideally be integrated into everyday tasks (eg. reaching for a cup)

74
Q

Standing up

A

practicing standing up should be undertaken by people who have difficulty in standing up from a chair
repetitive task specific training

75
Q

Standing

A

task specific standing practice with feedback can be provided for people who have difficulty standing

no intervention approach is superior to another
minimal evidence to support significant differences in standing balance with regards to postural sway or outcome measures

76
Q

Walking

A

people with difficulty walking should be given the opportunity to undertake tailored, repetitive practice of walking/components of as much as possible

extra interventions that can be including with walking are
cueing of cadence
mechanically assisted gait (treadmill/robotic device)
joint position feedback
virtual reality training

ankle foot orthoses, individually fit, can be used for people with persistent foot drop

77
Q

high intensity resistance training has shown what outcomes

A

improved gait speed and functional outcomes

78
Q

fitness training has what effect on walking

A

significant positive effect

79
Q

what is limb apraxia

A

impaired planning and sequencing of movement that is not due to weakness, incoordination or sensory loss

80
Q

what is agnosia

A

inability to recognise sounds, smells, objects or body parts despite having no primary sensory deficits
- disabling and dangerous
the presence of agnosia should be assessed by appropriately trained personnel and communicated to the stroke team

81
Q

What is neglect

A

failure to attend to sensory or visual stimuli on or to make movements towards one side of the environment

typically left side due to lesions in the right hemisphere
Deleterious effects on all aspects of ADL’s and is a predictor of functional outcome

82
Q

interventions that can be trialled on patients presenting with neglect

A

simple cues to draw attention to affected side
visual scanning training in addition to sensory stimulation
Prism adaptation
eye patching
mental imagery training or structured feedback

83
Q

Treatment planning includes

A
prioritising functional limitations
analysing each functional limitation with consideration of the task and ICF
-Task analysis 
- movement dysfunction 
ICF analysis 
- environmental factors 
-Personal Factors
- Functional factors 
-Physical impairments
84
Q

comprehensive treatment plans include

A

SMART goals
specific treatment strategies for each problem
identify resting positions
identify handling/assistance requirements for health professionals or family/carer during bed mobility, transfers, sitting, standing, mobility
identify mobility level
identify practice that can be carried out independently by patient or with assistance from family/carer

85
Q

how to maximise feedback during treatment sessions

A

visual feedback: mirrors, video, targets, scales
Auditory feedback : verbal, biofeedback
Sensory feedback: handling, tactile facilitation, strapping, compression (bandaging/tubigrip)

86
Q

Interventions must be

A

goal directed with measurable outcomes
functional tasks or components of functional tasks
distance achieved, time to perform, number of reps, number of errors to make it measurable